1.0    Name of Programme
The designation of the programme is Graduate Entry Medical Programme (GEMP). The duration of the programme shall be four (4) years. 

The initial phase of one and a half (1½) years of the programme is run on a semester basis and not as course credit system, in an integrated approach.

2.0    Entry Requirements
This is a full-time, non-residential, GEMP full-fee paying medical programme with the following entry requirements.

Eligible candidates:

• must hold a good First Degree (Second Class Lower or better) in Basic Medical, Biological, Biomathematical, Physical Sciences, or any relevant science related subject.
• must show evidence of having completed the National Service, where required
• must pass a 3-hour written Entrance Examination conducted by the UGMS.

The Examination will comprise the following:-

• General Knowledge, General Science (Chemistry, Physics, Biology) and aspects of Level 200 Science
• Reasoning: English (Composition and Expression); Mathematics, Basic Statistics, a combination of MCQs and Essays
• MCQs on the Sciences (Chemistry, Physics, Biology)              -    50%
• Short Essays: General Knowledge, Reasoning Ability and English  -     50%
• must pass a selection interview

A three (3) week revision course will be run for prospective candidates.  Details of the courses/subjects to be taught will be organized by module coordinators to prepare prospective candidates for the entrance examination.

3.0    Justification
The University of Ghana Medical School (UGMS) has an institutional mandate to train medical students to graduate as highly qualified and competent medical doctors to take care of health-related issues in Ghana. Furthermore it strives to achieve world class standards to compete internationally.

Over the years, intake of medical students into the four (4) medical schools in the country has been very limited due to the many challenges that restrict access to the various schools.  
In the UGMS, training of doctors has been limited to a 5½ year programme due to the inherent challenges including entry qualification, which bothered on the maturity of entrants into the traditional programme.  Additionally, a large number of applicants who apply to do medicine, in the UGMS for example, do not get the opportunity. 

In fact, out of about 900 students who apply to do medicine from Level 100 of the Faculty of Science, Legon each year, only 150 are admitted.  The University of Ghana Medical School, since its establishment in 1964, has so for produced only 2,154 doctors.  The average yearly output of doctors for the past five years is about 82. 

Consequently, otherwise good science students end up in various non-science professions after their first degree.  This has contributed to the high patient/doctor ratio in the country.  Information from the Ministry of Health “Human Resource Policies and Strategies for the Health Sector, 2007-2011”, paints the following picture:-

“In 2005, the doctor population ratio in Ghana was estimated to be 1:10,700, compared to South Africa (1:1,449) in 2001, USA – 1:182 (in 2000) and Cuba – 1:169 (in 2002).  The Ministry of Health aims at achieving a ratio of 1:6000 by 2011.  National Statistical Service, 2000 report projects that the population of Ghana will increase to about 24.5 million by 2011.  It was concluded in the report that, for Ghana to attain a middle-level income status, as envisaged in the government’s mission, it is necessary to accelerate the production and retention of critical health staff.  The goal is to achieve the World Bank recommendation of 1.8 doctor to 1000 population (World Bank, 2001)”

The situation is even more critical in the districts. Northern Ghana is worse hit by a doctor: patient ratio of 1:95,000. Added to this, the health sector has fallen victim to the brain drain.  The recent call on all Provosts, Deans/Directors by the Pro-Vice Chancellor of the University of Ghana to introduce new programmes, taken together with the request by the Ghana Medical and Dental Council to produce more doctors of a high caliber in a shorter period, have encouraged the UGMS to take the bold step to prepare to admit first degree holders to a 4-year graduate entry medical programme.  This also conforms with the modern trend in medical education to encourage first degree holders to study medicine. 

The traditional medical programme currently being run at the UGMS with intake from Level 100 Biological Sciences has a duration of 5½ years. Of this intake, less than 3% per year are first degree holders who, on entry, also pursue a 5½ year training. It has been established by what pertains in several countries including the U.K., the U.S.A., Canada, Europe and Australia that first degree holders who are more mature can be trained to be competent doctors over a shorter period of 4 years.  Recently, a further innovation of a 3-year programme has started in some parts of North America.  

The historic model of traditional medical education of the United Kingdom, on which the UGMS was based, has transformed significantly with regards to traditional teaching and is making way for problem-oriented and student-centered learning strategies. Graduate entry medical programmes are now on the increase.  

Adopting the 4-year medical programme alongside the traditional 5½ year programme at the UGMS, as currently occurs in some U.K. medical schools, would ensure that more doctors are trained within a shorter time to offset some of the challenges outlined above.  Identifying candidates with the right attitude of passion and commitment for the medical profession has not been an easy task.  Certainly, this group will, after a well-thought out selection process, present an easier challenge.

It is also hoped that this relatively mature group will have broader experiences with previous university training, work and the community participation to enrich their training.  Personal communication with alumni involved in GEMP has confirmed that they are more mature and relatively easy to handle and therefore are more likely to take up the challenge of student-centered learning with some facilitation.

Faculty members and external examiners have consistently drawn the UGMS attention to lapses in application of pre-clinical sciences and theory to clinicals and we think integrating the course may rectify this challenge.

Furthermore, the Visitation Review Implementation Committee reports “an expressed preference for further consideration of how the first year could be combined with the final 3-year to provide a 4-year degree programme”.  The GEMP will be the pilot programme of the UGMS for this transformation which will employ the modern trend of integrated medical programmes.  This Pilot Project will be used as a basis to plan further changes in UGMS curriculum to meet modern trends in medical education. 

4.0    Aims and Objectives

1. To turn out more doctors to meet the ever-increasing demand.
2. To train graduates to acquire clinical competence to work as medical officers within the shortest possible time.
3. To produce graduates who will have a habit of life-long, self-directed learning, required for a career in a dynamic health service system, postgraduate studies, and scientific research.
4. To offer opportunity to otherwise suitably qualified candidates who could not be admitted into the traditional programme.

5.0    Training Outcomes
As with all graduands from the UGMS, graduates of the programme should be able to:

1. show a clear understanding of the physical, biological and behavioural mechanisms of health problems
2. identify health problems and exhibit skills in collecting, analyzing and presenting information relevant to the problems, and to manage them at individual, family and community levels
3. develop the clinical skills and methods required to diagnose and manage frequently occurring diseases in the community, including emergencies, and to manage health problems of patients, including their physical, emotional, and social facets, within the context of effective healthcare
4. to apply basic principles in health education to assist and lead planning, implementation and evaluation of health programmes in promoting health, preventing disease, cure and rehabilitation, in line with community needs
5. function as an effective and efficient member of the health team with a sense of responsibility, dependability and accountability
6. recognize, maintain, and develop the personal characteristics and attitudes required for a career in the medical profession, including enhancing their knowledge through recognizing personal educational needs, self-directed learning, selecting appropriate learning resource and evaluating personal progress.

6.0    Philosophy
The traditional 5½ year medical programme is geared towards training doctors competent enough to eventually function as District Medical Officers of Health.  With the establishment of the Ghana College of Physicians and Surgeons, which caters for postgraduate training in the various fields of clinical medicine, family medicine and public health, the focus of medical training needs to change with emphasis on producing competent doctors who can then progress to postgraduate courses to upgrade the manpower and specialist base of the Ghana Health Service. 
There is a need to shift focus on TEACHING STUDENTS in the traditional medical education to developing STUDENT CENTERED LEARNING approach in modern medical education, a great asset for continuous professional development, postgraduate training and RESEARCH. 

Furthermore, in the traditional 5½-year programme, subjects are taught separately so that there is a lot of overlap due to repetition of information across subjects.  These overlaps are inevitable for emphasis for the level of maturity of the younger students in the programme.  In the 4-year programme, with more matured students entering the programme, it is possible to integrate the subjects early, with emphasis on student-centered and independent learning, and therefore do away with the overlaps and unnecessary repetitions without compromising standards as the students have greater ability to perform at higher cognitive levels.  It also conforms with the modern trend where clinical training is introduced early in the curriculum to be appreciated in the right context.

7.0    Intake of Students
An initial student intake of 50 GEMP full-fee paying students, to rise to 50% of total admissions into the school.

8.0    Programme Code
The programme code is GEMP

9.0    Programme Outline
The entry point is Level 300. 

The programme will be run in modules as a highly integrated course both horizontally, in that the disciplines within medicine are learned together, and vertically, in that clinical work and clinical relevance are introduced from the very beginning.  

The programme is divided into two phases.

• Phase 1 -1½ years, will comprise three (3) Semesters
• Phase 2 - 2½ years, junior and senior clinical clerkships

10.1    Phase 1
Phase 1 runs over 3 semesters covering 1½ years. Year one (1), is divided into two semesters (Level 300) and the first half of Year two (2), Level 400, is the third semester.

• Duration of semester – 19 weeks
• 17 weeks of teaching
• One (1) week revision
• One (1) week examinations

10.1.1    Organisation of Modules
The programme will be run on a modular basis. 
The teaching format is to be adopted for semesters one (1) and two(2) are:

• Lectures and tutorials in the morning
• Patient centered clinical activity)
• Laboratory Practical (in the afternoon)
• Self-directed learning (in the afternoon)

For semester three (3), the patient-centered clinical attendance, self-directed learning and tutorial/practical would be in the morning and lectures would be in the afternoon.  Early Clinical training will be carried out using the clinical skills and simulation centre, as well as relevant direct exposure to patients, with emphasis on student self-directed learning.

10.1 Module Structure

Table 1.  module structure.

10.2.1    Time tabling
Morning sessions will be from 7.30am – 1.00pm with a 30 minute break, lunch break from 1:00 to 2:00pm, while the afternoon session will be from 2.00pm – 5.00pm. (See Page 10.)

The time table below (Table 2.) shows the time schedules for the core modules proposed for each day from semester 1 – 3. The scheduling of activities within the sessions for any particular module is the responsibility of the module team, headed by a module leader.

10.2.2    Module Coordinator
A module coordinator is the person responsible for coordinating all the activities within a module and should be teaching a topic in the module. A module coordinator, in conjunction with members of the team, is responsible for the day to day management of the module within the programme, the design, teaching and learning approaches. The module coordinator will also ensure the following: 
a)    that content and learning outcomes for each module, are written
b)    that assessment procedures are adhered to
c)    that the coordination and monitoring of assignments are done
d)    that collation of questions for the module is taken care of
e)    that evaluation of the module for subsequent improvement is done 

10.3    Assessment
All modules and activities in Phase 1 are core and therefore compulsory.

Students will be assessed in the following forms:

10.3.1    Formative Assessment
Students will be assessed through:
i) Assignments 
Assignments will be given and marked periodically. The module coordinator, together with the team, will determine the number of assignments per module per semester.
ii) Theory Assessment
There would be three assessments made up of objective tests and short essays.  These assessments will be conducted during week 4, week 9, and week 14.
iii) Clinical Work/Patient-Centered Clinics/Laboratories
Assessment will be by Objective Structured Clinical Examination (OSCE) and Objective Structured Practical Examination (OSPE) – not less than 2 per module per semester.
iv) Attendance
A student must have attended at least 80% of lectures, tutorials, practicals and clinical work during the semester to be eligible to take the end-of-semester examination.  An attendance register will be used at all lectures, tutorials and clinics. To be absent for medical reasons for up to a maximum of consecutive 5 days, a medical certificate should be provided.

10.3.2    Pass mark for a module
The Pass mark for a module is 50%. The Formative Assessment mark would form 50% of the final mark of the End of Semester Examination.

10.3.3    Summative Assessment For 1st and 2nd Semesters
This examination will contribute 50% to the final semester mark. 

There will be two theory papers and an oral examination: 
•    Paper 1 – MCQs  
•    Paper 2 – long and short essays
•    Oral examination: to assess integration of the modules taught 
The weighting of the components of each examination shall be 50:40:10

10.3.4 Summative Assessment for Semester 3
At the end of the third semester, students will be assessed through MCQ’s, long/short essays as well as OSCE/OSCPE and oral examination with the weighting of the components being 30:30:30:10. 

10.3.5    Re-sit Examinations
There will be two re-sit examinations:
i)    After End of Semester 2 examinations – to re-sit failed End of Semesters 1 and 2 examinations within 4 weeks.
ii)    After Semester 3, to re-sit failed Semester 3 examinations within 4 weeks.

A student who fails in:-
a.    more than two modules in the formative assessment is not eligible to write the end-of-semester examination.
b.    the End of Semester examination shall be asked to re-sit the examination at the scheduled time
c.     maximum of 3 resit attempts

10.3.6    Progression to Phase 2
To progress to Phase 2, a student must score at least 50% in each module and must have passed all end-of-semester examinations.

11.0    PHASE 2 
This phase is predominantly clinical with relevant phase 1 integration and will be exactly as the existing regular programme.  
The phase is divided into two:
Part 1 – Junior Clerkship
Part 2    - Senior Clerkship

11.1    Duration and areas to be covered during the Junior and Senior Clerkships
This will remain as approved for the regular MBChB program

11.2    Assessment
Phase 2 Examinations

• Final Part 1 – Child Health and Obstetrics & Gynaecology after senior clerkship in O&G and Child Health
• Final Part 2 – Internal Medicine, Surgery and Community Health after senior clerkship
• Weighting of Part 1 and Part 2 examination marks
• Formative – 30% of final mark
• Summative – 70% of final mark

To pass the Part 1&/or 2 examinations, a student should have passed the clinical examination and obtained a minimum of 50% mark in the total of the formative and summative assessment. 

11.3    Notes

• The Nursing week is incorporated in the Phase 1 curriculum
• Community Diagnosis course of the Community Health Department is incorporated in Phase 1
• An introduction to dentistry has been incorporated in Phase 1.

12.0    Graduation
The degree to be awarded is MB.,Ch.B.  
Eligibility for the award of MB.,Ch.B degree
To graduate, the candidate should have satisfied the examiners in End of Phase 1 examination and obtained at least 50% in the Parts 1 & 2 Examinations.

13.0    Supplementary Examinations
13.1    Supplementary examinations for Part 1 shall be held six weeks after the main examinations.
13.2    Supplementary examinations for Part 2 shall be held 15 weeks after the main examinations or as indicated in the regulations for MBChB examination.

14.0    Fees to be Charged
The forces of curriculum changes, devolution of resources from public tertiary institutions, the financial squeeze on university coffers have resulted in enormous challenges to medical education.  
Proposed fees for Ghanaian quota- $6,000 dollars equivalent in Ghana cedis, Foreign quota $12,000. The institution reserves the right to review at any time without notice.

15.0    General Comments
a)    The aims, objectives and expected outcomes for all modules will be provided by the module teams.  
b)    The team should determine which topics in a module will be delivered as lectures, tutorials or self-directed learning.
c)    The module coordinator will assist the GEMP Coordinator to effect implementation, evaluation and further development of the module.

Table 2. Time-Table for Phase I of Graduate Entry Medicine Programme

* Tutorials, practicals or laboratory sessions, simulation and skills centre learning, Patient-Centred Clinics, clinical demonstrations and self-directed learning activities.